Senate President Pro Tempore

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Senator Looney Leads Passage of Patient-friendly Health Care Reforms

Senate President Pro Tempore Martin M. Looney (D-New Haven) yesterday led unanimous bipartisan passage of two patient-friendly health care reforms that will reduce the time from 72 hours to 48 hours for health benefit reviews and requires health insurers to authorize a covered person’s pharmacy to dispense a temporary supply of a prescribed drug when the covered person, or his or her authorized representative, files a grievance or requests an adverse determination review related to the drug.

“Under the current system, an insurer has 72 hours to respond to an urgent care request; in some cases 72 hours can put a patient in serious danger,” said Senator Looney. “Reducing that timeframe can potentially save lives.”

Senate Bill 209, An Act Reducing the Time Frame for Urgent Care Adverse Determination Review Requests, shortens, from 72 to 48 hours, the maximum time for certain health benefit reviews. It applies to:

certain urgent care initial utilization reviews,

internal adverse determination reviews, and

external or final adverse determination reviews.

These reviews are conducted by health carriers (e.g., insurers and HMOs) or, in the case of external or final reviews, independent review organizations (IROs) and are one factor used to determine if a specific medical service is reimbursable by the individual’s health plan.

The bill does not apply to urgent care reviews involving substance use disorders and certain mental disorders, which by law must be completed within 24 hours.

SB 380 An Act Requiring Health Insurance Coverage of a Prescribed Drug During Adverse Determination Reviews and External Review Processes, addresses the situation in which a patient is prescribed a drug and the insurer defies the physician’s order and determines that the drug is not medically necessary for the patient. This proposal would require the insurer to cover the drugs during the course of the appeal. It would provide protection to patients during the course of the entire appeal process.

“This legislation would assist patients in receiving appropriate care that has been authorized by a patient’s treating physician,” said Senator Looney. “In addition, it would encourage the insurer to resolve the appeal with reasonable speed. It is also important to make sure that the ACA’s protections for concurrent reviews are included in Connecticut statute.”

This bill requires health carriers (e.g., insurers and HMOs) to authorize a covered person’s pharmacy to dispense a temporary supply of a prescribed drug when the covered person, or his or her authorized representative, files a grievance or requests an adverse determination review related to the drug. The bill applies to initial utilization reviews, internal grievance reviews, and external reviews. These reviews are one factor used to determine if a specific medical service is reimbursable by the individual’s health plan.